NEW ORLEANS — Melanoma is seen more often among patients diagnosed with chronic lymphocytic leukemia than in the general public, but it did not appear to have a negative impact on survival, researchers reported at the American Society of Hematology meeting here.
“We find in our cohort of chronic lymphocytic leukemia patients a higher prevalence — an eight-fold higher rate — of melanoma than the general public,” said Timothy G. Call, MD, assistant professor of medicine at the Mayo Clinic School of Medicine in Rochester, Minn.
“However,” he said, “the diagnosis of melanoma and nonmelanoma skin cancer … does not appear to be a risk factor for adverse chronic lymphocytic leukemia outcomes or for shorter outcomes.”
Call and his colleagues combed the Mayo Clinic database and identified 2,240 patients in a 15-year period who were diagnosed with chronic lymphocytic leukemia. Of this cohort, 293 patients — 13.1% of the total — had also been diagnosed with nonmelanoma skin cancer, and 57 patients had been diagnosed with melanoma.
The prevalence of melanoma in CLL patients was higher than that of the age-adjusted prevalence for individuals in the Iowa SEER (Surveillance, Epidemiology, and End Results) registry (2.5% versus 0.03%; P<0.001).
About 60% of the patients were diagnosed with skin cancer following or around the time of their initial diagnosis of chronic lymphocytic leukemia, the researchers reported in a poster presentation
“Since the presence of skin cancer could be a marker of immune dysregulation, we hypothesized skin cancer may be associated with the clinical outcome of chronic lymphocytic leukemia,” Call said. “Accordingly, we evaluated the relationship between nonmelanoma skin cancer and melanoma skin cancer and time to first treatment and overall survival,”
Among those with melanoma, there was no difference in time to first treatment or overall survival compared with those who were not diagnosed with the aggressive form of skin cancer.
However, when it came to nonmelanoma skin cancer, the researchers found a surprising inverse relationship. Time to first treatment for chronic lymphocytic leukemia was longer in those with nonmelanoma skin cancer — about six years — compared with those patients who did not have skin cancer, 4.9 years (P=0.04).
Similarly, among those patients with nonmelanoma skin cancer, median overall survival was 10.8 years compared with 9.7 years for those who did not have skin cancer (P=0.02).
Call said that chronic lymphocytic leukemia patients diagnosed with nonmelanoma skin cancer were older with a median age of 67 compared with 63 for those patients without skin cancer (P<0.001). The same was true for melanoma patients whose median age was 70 compared with 64 for those without a melanoma diagnosis (P=0.002).
“Skin cancer prevalence in these patients appears to be elevated when compared with the general public and may be related to the fact that people with chronic lymphocytic leukemia have an altered immune system in general,” said Ephraim Hochberg, MD, director of clinical lymphoma research at Massachusetts General Hospital/Harvard Medical School, Boston.
He said that the prevalence of nonmelanoma skin cancer in the Mayo cohort is about three times that seen in the general population.
Call made no relevant disclosures. However, his co-authors included financial relationships with Biogen-Idec, Celgene, Genentech, genmab, Hospira, Polyphenon Pharma, sanofi-aventis, Bayer, Genzyme, Novartis, Polyphenon E International and Bayer Health Care Pharmaceuticals.
Hochberg has disclosed financial relationships with Amgen Inc.; Biogen Idec; Enzon Pharmaceuticals, and Genentech.